2014 vascular access art

Pediatrics

Vascular AccessArterial Catheterization

xxx00.#####.ppt 07/01/16 12:57 AMPediatrics

Objectives

•By the end of this workshop, the learner will be able to:

‐Recall at least 3 indications and 3 contraindications for arterial catheterization

‐Name at least 5 complications associated with arterial catheterization

‐Describe the anatomic landmarks used to guide arterial catheterization at specified sites of insertion

‐ Identify the potential sites for arterial catheterization

‐Choose the appropriate sized vascular catheter according to the patient’s size


3 Simple Steps

Obtain

Prepare

Perform


3 Simple Steps

Obtain informed consent

Prepare

Perform


Indications

•Arterial blood sampling

‐Oxygenation

‐Ventilation

•Frequent blood sampling

•Continuous monitoring of blood pressure


Contraindications

•Known deficiencies of collateral circulation

•Infection at site of insertion

•Trauma injury

•Coagulopathy


Complications

•Arterial spasm

•Thrombosis

‐Mottling proximal/distal to catheter site

•Emboli

•Hemorrhage

‐Axillary sheath hematoma

•Infection

‐Low incidence

•Skin necrosis

•Fistula

•Aneurysm

•Brachial plexus injury


3 Simple StepsObtain informed consent

Prepare for placement

Perform


Preparation

•Proceduralist

•Patient

•Equipment


Proceduralist

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Timeout

•Right procedure

•Right patient

•Right side

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Sterile gowning

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Preparation

•Proceduralist

•Patient

•Equipment


Sites for Insertion

•Radial/Ulnar

•Axillary

•Dorsalis pedis

•Posterior tibial

•Femoral


•Anatomy

•Surface Landmarks

•Positioning


Radial

•Most common site

•Lies in longitudinal groove formed by FCRM and distal radius

•Check for collateral flow

•Thrombosis is common


Dorsalis pedis

•Descends down dorsum of foot parallel & lateral to EHLT

•Check for collateral flow

‐Occlude artery

‐Blanch great toe for several seconds

‐Release pressure & observe for flushing


Posterior tibial


Axillary

•Large artery

•Excellent collateral flow

•Air/thrombus embolism can cause brain/hand ischemia


Femoral

•Also large artery

•May still be palpable with marked hypotension

•Lack of collateral flow

•Air/thrombus embolism can cause foot/toe ischemia


Patient


Preparation

•Proceduralist

•Patient

•Equipment


Choosing a Catheter

•2.5 F and 2.5 cm

•2.5 F and 5 cm

•3 F and 5 cm


3 Simple StepsObtain informed consent

Prepare for placement

Perform the procedure


Administer medications


Sequence of Events

Inform/Consent parents

Perform a “Time Out”

Position

•Perform Procedure/Apply sterile dressing

•Confirm Placement

•Document


Sequence of Events



Position

Perform Procedure/Apply sterile dressing

•Confirm Placement

•Document


•Confirm via pressure transduction and blood gas

•Tubing used for pressure monitoring should include a Luer-lock design

•Papaverine-containing heparin solution prolongs arterial catheter life

•If you cannot transduce……


TAKE IT OUT!!!

TAKE IT OUT!

TAKE IT OUT!!


Sequence of Events



Position

Perform Procedure/ Apply dressing

Confirm Placement

•Document


STATIONS

•Ultrasound/PIV/IO

•US-guided CVC

•Arterial line placement

•CVC via landmark technique


•Practice :

‐PIV and IO placement using a task trainer

‐ the steps for prepping and draping a site prior to:

•Central venous catheterization according to TCH PICU insertion bundle

•Arterial catheterization

•Execute the proper sequence in the placement of:

‐Ultrasound-guided central venous catheters

‐Arterial catheters according to an itemized checklist

•Integrate the “landmark technique” and use of ultrasound when performing central venous catheterization as recommended by governing/certifying bodies

2014 vascular access art

Education